Merit Research Journal of Medicine and Medical Sciences (ISSN: 2354 2354-323X) Vol. 4(2) pp. 111-120,, February, 2016 Available online http://www.meritresearchjournals.org/mms/index.htm Copyright © 2016 Merit Research Journals
Original Research Article
Association of psychiatric morbidi morbidity ty and coping strategies among service personnel of an army formation in Nigeria Nigeria, West Africa Adole Oloche, *Armiya’u Armiya’u Aishatu Yusha’u Yusha’u, Audu Moses David and Obembe Ayodele Abstract
Department of Psychiatry, Jos University Teaching Hospital, Jos, Plateau State *Corresponding Author’s Email:
[email protected]
The concept of coping is considered by the authors to be important to understanding the psychological outcomes of the stresses of military experiences in a developing multi multi-ethnic, multi-religious religious society with its problems of internal conflicts, growing infrastructure ructure and developing economy. Coping mechanisms/strategies play a role in psychological maladjustments in relation to occupational tasks particularly in the military. military To o determine correlations, if any, between coping strategies and psychiatric morbidity and also to compare psychiatric outcomes among troops who use emotion focused coping and those who use problem focused coping. A cross sectional descriptive study carried ed out among 193 servicemen. Samples were drawn by stratified multistage sampling in which respondents were stratified according to gender, military units and rank. Data was collected using a socio-demographic phic questionnaire, the full COPE COP scale, the General Health Q Questionnaire (GHQ) 12 and interviewed with the Composite Inter International Diagnostic Interview (CIDI). Nine out of the 15 coping strategy domains had statistically significant correlations with morbidity. Logistic regression result showed that three coping strategies were independently associated with psychiatric morbidity. We recommend a curriculum on coping skills training for the Army Army. The study found a significant relationship between coping styles and morbidity with emotion focused coping showing a greater positi positive ve correlation with morbidity. Keywords: Association, Coping strategies, Nigerian Army, Psychiatric morbidity, Service personnel
INTRODUCTION Military service is associated with higher stress levels (physical conditions, sleep deprivation), while habitual coping strategies, such as arbitrary social environments, are neither adequate nor useful (Mueller et al., 2009) 2009). The high stress levels of military service and associated maladaptive behaviour was reported eported in relation with physical safety (Mueller et al., 2009) 2009). The specific correlations with coping styles of the conscripts were, however, not reported. Spence et al. (2002) found that
poor coping strategies were related to depression so also Lai in his Master’s thesis on study of stress, depression symptoms and coping behaviours in recruited soldiers at the National Defense Medical Center, Taipei, Taiwan. Taiwan He observed an association between coping mechanisms and depressive symptoms with the raw soldiers soldie (Spence et al., 2002; Lai, 2004).. He reported that very depressed people adopted a coping strategy of escape; the more they relied on emotional coping strategies, the more
112 Merit Res. J. Med. Med. Sci.
severe their depression (Lai, 2004). If the participants in his study thought the problem could be solved, they tended to adopt an active, problem-resolving strategy aimed at countering the source of the stress through direct action and if they thought the problem would be hard to solve, they tended to adopt a passive strategy such as escaping, staying way, or temporarily stepping back (Lai, 2004). Dhir et al studied neuroses among armed forces personnel and their families in a large cantonment of the Indian army. They found that the overall prevalence of neuroses was 31.34% with 95% confidence interval between 27.41% and 35.55% (Dhir et al., 2008). They observed that neither gender nor marital status had any effect on prevalence of neuroses and noted that neuroses were more common in the lower ranks and among troops who belong to the combat arms compared to services and strongly recommended preventive psychological services in the armed forces (Dhir et al., 2008). The study focused on neuroses in a combined population of 300 servicemen and 300 wives (Dhir et al., 2008). No correlations were reported with length of stay on a rank (such as career stagnation) or with coping strategies and the study did not identify modifiable issues such as coping styles that could be manipulated to influence psychiatric morbidity, but rather appears to have focused mainly on largely un-modifiable factors such as age etc. Published works in Coping studies in African populations (especially military) are relatively uncommon, but alcohol/substance misuse which is also a known maladaptive coping mechanism was studied by Cheng et al in the Angolan military; it was stressed that most studies examining risk factors for maladaptive coping with substance/alcohol misuse among soldiers have relied on US military personnel and may have limited applicability to military populations of developing nations (Cheng et al., 2011). Nonetheless, results of their work provide guidance for initial research with African military populations and a guide towards possible maladaptive coping. Such works found that military culture's emphasis on risk-taking has been associated with problematic alcohol and some cases other psychoactive substance consumption (MacQueen et al., 1996; Hunter et al., 2000; Ames and Cunradi, 2004/2005; Ames et al., 2006). Similarly, these studies also cited by Cheng noted that combat-related stress, being away from home and ease of acquiring alcohol near military bases appear to contribute to problematic drinking, a maladaptive coping mechanism (Ames and Cunradi, 2004/2005; Ames et al., 2006; Bremner et al., 1996; Mehlum, 1999; Koenen et al., 2003; Galen and Rogers, 2004; Karlovic et al., 2004; Moore et al., 2007; Hooper et al., 2008). The effects of use of alcohol, emotional support and turning to religion as coping mechanisms could also be inferred from Cheng’s work which demonstrated that the proportion of
drinkers who were married or attended church was significantly smaller relative to non-drinkers (Cheng et al., 2011). Attending religious services more than once a week appeared to protect against problematic drinking while not being married or never attending religious services almost doubled the likelihood of having consumed alcohol during the past year (Cheng et al., 2011). Though military studies of coping are absent and those of psychiatric morbidity few in Nigeria; Okulate in 2005 demonstrated differences in the pattern of psychiatric referrals and psychiatric diagnoses among Nigerian military personnel in peace and at war times (Okulate, 2005). The findings may only be viewed as hinting at a difference in the mental reaction to stress of varying nature. However, the study did not specifically correlate these disorders with troops coping styles. METHODOLOGY The study was a cross sectional descriptive study comprising of 193 servicemen 177 males and 16 females. Sample was drawn by stratified multistage sampling in which participants were stratified according to gender, military units within the cantonment and rank. Data was collected in 2 stages. The socio-demographic questionnaire, the full COPE scale and the general health questionnaire (GHQ) 12 were administered to the respondents at the first stage. Second stage was interview with the WHO Composite International Diagnostic Instrument (CIDI) for respondents with a general health questionnaire (GHQ) 12 score of 2 and above. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. Frequency counts and chi square were used for categorical variables. Continuous variables were analyzed by mean, and a probability of 5% was regarded as statistically significant. RESULT Table 1 shows the age distribution of respondents. Age ranged between 22 and 57 years with a mean age of 37.8 ±8.7 years. More than half (56.3%) of the females and about 1 in 5 (20.9%) of males were below the age of 30 years. A little more than a tenth (11.3%) of males but none of the females were 50 years and above. One hundred and fifty six (80.8%) of the subjects were married. None of the females was divorced or widowed. (Table2a). About half (12.4%+38.3% = 50.7%) of all respondents were junior soldiers comprising junior noncommissioned officers (JNCO) and private soldiers while senior non-commissioned officers (SNCO) and commissioned officers made up 42.5% and 6.7%
Adole et al. 113
Table 1. Gender distribution
Age
Gender Category
Total
Female N 9 4 3 0 16
20 – 29 30 – 39 40 – 49 50+ Total
Male
% 56.3% 25.0% 18.8% 0.0% 100.0%
N 37 60 60 20 177
% 20.9% 33.9% 33.9% 11.3% 100.0%
N 46 64 63 20 193
% 23.8% 33.2% 32.6% 10.4% 100.0%
Table 2a. Marital Status Distribution
Marital Status
Gender
Total
Female N 7 9 0 0 16
Single Married Divorced/Separated Widowed Total
Male
% 43.7% 56.3% 0.0% 0.0% 100.0%
N 25 147 3 2 177
% 14.1% 83.1% 1.7% 1.1% 100.0%
N 32 156 3 2 193
% 16.6% 80.8% 1.6% 1.0% 100.0%
Table 2b. Rank Distribution
Rank Category
Gender
Total
Female Privates JNCO SNCO Officers Total
N 5 4 5 2 16
Male
% 31.3% 25.0% 31.3% 12.5% 100%
N 19 70 77 11 177
% 10.7% 39.5% 43.5% 6.2% 100%
N 24 74 82 13 193
% 12.4% 38.3% 42.5% 6.7% 100.0%
Table 3. Distribution of GHQ Cut Off
GHQ Score Less than 2 Greater than or equal to 2 Total
Frequency 105 88 193
Percent 54.4% 45.6% 100.0%
Table 4. Lifetime and 12 Month Prevalence of Morbidity
Morbidity Nil Life Time 12 Months
Frequency 145 48 45
respectively (Table 2b). Table 3 show the distribution of GHQ12 scores among respondents. Eighty eight (88) respondents (45.6%) scored 2 and above while 105 (54.4%) scored below the cut off point for the CIDI interview. The mean GHQ 12 score was 1.92 with a mode score of 1 (n=56).
Percent 75.1% 24.9% 23.3%
Table 4 shows the prevalence of any psychiatric morbidity with a CIDI diagnosis of lifetime psychiatric morbidity. It shows that 24.87% had at least one lifetime psychiatric morbidity and 75.13% had none. Figure 1 shows that depression (25.3%) and specific phobias (24.0%) are the most common diagnoses, each
114 Merit Res. J. Med. Med. Sci.
Figure 1. Bar chart showing frequency of CIDI diagnosis among respondents.
Table 5. Distribution of Psychiatric Diagnoses
Number of Diagnoses Social Phobia Specific Phobia Depression Dependence Generalized Anxiety Disorder IED Psychosis Post Traumatic Stress Disorders Bipolar Affective Disorder Panic Disorders Total
Gender Female Count % Count % Count % Count % Count % Count % Count % Count % Count % Count % Count
1 16.7% 5 27.8% 1 5.3% 0 0.0% 0 0.0% 0 0.0% 1 33.3% 1 50.0% 0 0.0% 1 25.0% 10 13.3%
constituting about a quarter respectively of all the diagnoses. Their lifetime prevalence was 9.8% and 9.3%
Prevalence Male 5 83.3% 13 72.2% 18 94.7% 16 100.0% 4 100.0% 2 100.0% 2 66.7% 1 50.0% 1 100.0% 3 75.0% 65 86.7%
Total 6 8.0% 18 24.0% 19 25.3% 16 21.3% 4 5.3% 2 2.7% 3 4.0% 2 2.7% 1 1.3% 4 5.3% 75 100%
3.11% 9.32% 9.84% 8.29% 2.07% 1.04% 1.55% 1.04% 0.52% 2.07% * 38.85%
respectively. Table 5 shows there were 75 positive psychiatric
Adole et al. 115
PTSD
BAD
Panic Disorder
-.031
.049
.053
.032
-.028
-.068
.049
.502
.545
.672
.496
.462
.663
.702
.344
193 .084
193 .040
193 -.059
193 .002
193 * -.166
193 -.041
193 -.078
193 .043
193 .113
193 .001
.826
.243
.579
.416
.976
.021
.570
.281
.556
.118
.988
Turning Religion
to
193 .105
193 -.006
193 -.011
193 * -.141
193 -.040
193 -.062
193 -.044
193 .029
193 .077
193 -.031
193 -.091
.147
.932
.878
.050
.581
.390
.546
.693
.288
.670
.209
Focus on and venting of Emotions
193 ** -.293
193 .077
193 ** .321
193 .101
193 ** .196
193 .114
193 .135
193 .046
193 .007
193 -.008
193 .036
.000
.290
.000
.162
.006
.114
.061
.523
.920
.915
.616
Mental Disengagement
193 * -.152
193 .076
193 * .144
193 .068
193 .053
193 -.013
193 .070
193 .094
193 .030
193 -.049
193 * .184
.035
.291
.046
.350
.466
.854
.333
.192
.675
.502
.010
Behavioural Disengagement
193 ** -.208
193 * .158
193 .063
193 * .144
193 .024
193 .050
193 * .151
193 .036
193 * .168
193 .013
193 * .168
.004
.028
.381
.046
.745
.492
.036
.618
.020
.858
.020
Alcohol/Drug Use
193 * -.176
193 .118
193 .127
193 .079
193 * .166
193 .133
193 -.006
193 .033
193 -.006
193 -.047
193 * .162
.014
.103
.078
.276
.021
.064
.933
.645
.933
.520
.025
193
193
193
193
193
193
193
193
193
193
193
-.027
-.142
.202
.705
193 -.016
*
Psychosis
-.044
.092
IED
GAD
Seeking instrumental social support
Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N
Specific Phobia
Dependenc e
Active coping
Social Phobia
-.049
Normal
Depressio n
Table 6a. Coping Strategies and Significant Correlations with Diagnostic Categories
116 Merit Res. J. Med. Med. Sci.
diagnoses. The higher total number of N is due to co-morbidities. Males constitute over 4 in 5 (86.7%) and females just over 1 in 10 (13.3%) of all cases. Table 6a and 6b show results of a correlation matrix depicting only those coping strategies that showed significant correlations with psychiatric diagnosis using the Pearson Correlation with two tailed significance. The tables show that only 9 coping strategies were found to have significant relationships with diagnosed morbidity. The correlations matrix shows that “Focus on and Venting of Emotions” (p=0.000), “Mental Disengagement” (p=0.035), “Behavioural Disengagement” (p=0.004), “Alcohol and Drug Use” (p=0.014) were significantly negatively correlated with an assessment of “Normal”, while “Problem Focused Coping” had a positive correlation. (P=0.025); PTSD was positively correlated with “Behavioural Disengagement”
Panic Disorder
.079
.091
-.039
.024
.267
.273
.208
.591
193 .023
193 ** -.191
193 -.129
193 .013
193 -.048
193 -.021
.072
.754
.008
.074
.862
.503
.776
193
193
193
193
193
193
193
-.052
.070
-.096
-.180
.025
.472
.332
.186
193 .090
193 -.101
193 .039
.215
.164
193
193
*
IED
-.080
*
.161
GAD
BAD
Dependence
Depression
Specific Phobia
PTSD
Emotion Focused Coping
Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N
Psychosis
Problem Focused Coping
Social Phobia
Normal
Table 6b
-.163
.012
.095 .191
193 -.005
193 -.130
.587
.940
193
193
(p=0.020). Social Phobia was positively correlated with “Behavioural Disengagement” (P=0.028); Specific Phobia was negatively correlated with “Active Coping” (p=0.049), but positively correlated with “Focus on and Venting of Emotions” (p=0.000) and “Mental Disengagement” (p=0.046). Depression was negatively correlated with “Turning to Religion” (0.050) but positively correlated with “Behavioural Disengagement”. Dependence was positively correlated with “Focus on and Venting of Emotions” (p=0.006), “Alcohol and Drug use” (p=0.021) and negatively correlated with “Problem Focused Coping” (p=0.012). Generalized Anxiety Disorder showed a negative correlation with “Seeking Instrumental Social Support” (p=0.021); Intermittent Explosive Disorder showed a positive correlation with “Behavioural Disengagement” (p=0.036) and a negative correlation with both “Problem Focused
*
Coping “(p=0.024) and “Emotion Focused Coping” (p=0.008). Panic disorder was positively correlated with “Mental Disengagement” (0.010), “Behavioural disengagement” (0.20) and “Alcohol/Drug Use” (0.025). There were no statistically significant correlations of any particular coping strategy with psychosis or BAD demonstrated. Table 7 shows three coping strategies were significant predictors of morbidity in the regression model. Coping strategies of “Suppression of Competing Activities” (P=0.036) and “Focus on and Venting of Emotions” (P= 0.012) were significant positive predictors of morbidity. Thus the greater the use of these the higher the odds of developing psychiatric morbidity while the greater the use of “Acceptance” as a coping strategy, the lower the odds (P=0.016). There was no statistically significant association between the uses of Problem
Adole et al. 117
Table 7. Logistic Regression of Coping with Morbidity
Coping Strategy Active Coping Planning Seeking Instrumental Social Support Seeking Emotional Social Support Suppression of Competing Activities Turning to Religion Positive Reinterpretation and Growth Restraint Coping Acceptance Focus on and Venting of Emotion Denial Mental Disengagement Behavioural Disengagement Alcohol and Drug Use Humour Problem Focused Coping Emotion Focused Coping
B -.129 -.177 -.067 .125 .208 -.105 .180 -.088 -.217 .207
Wald 2.214 2.918 .544 1.652 4.401 1.043 3.351 .727 5.844 6.352
Sig. .137 .088 .461 .199 .036 .307 .067 .394 .016 .012
Exp(B) .879 .838 .935 1.133 1.231 .900 1.198 .915 .805 1.230
.066 -.020 .112 .009 .041 -.033 -.131
.673 .047 2.517 .011 .283 .124 1.105
.412 .828 .113 .917 .595 .725 .293
1.068 .980 1.118 1.009 1.042 .968 .877
95% C.I.for EXP(B) Lower Upper .742 1.042 .684 1.026 .782 1.118 .936 1.371 1.014 1.496 .735 1.102 .987 1.452 .747 1.122 .675 .960 1.047 1.445 .913 .817 .974 .856 .895 .807 .687
1.249 1.176 1.284 1.188 1.213 1.161 1.120
Table 8. Comparison of Problem Focused VS Emotion Focused Coping with Morbidity
Coping Strategy Problem Focused Coping Emotion Focused Coping
Morbidity Normal Morbid Total Normal Morbid Total
Focused Coping versus Emotion Focused Coping with morbidity among respondents (Table 8). DISCUSSION The study aimed at determining correlations, if any, between coping strategies and psychiatric morbidity and also to compare psychiatric outcomes among troops who use emotion focused coping and those who use problem focused coping. The strength of the study lies in the fact that standardized assessment methods were used in face to face interviews. The weakness of the study is that only a single military formation was used though the biggest in the state. There were far more males (91.7%) than females (8.3%) in the study with a proportion of 11.1:1. This markedly differs from the general population where females constitute 49% (Okulate, 2005) and also with the female population in the American army of 13.6% females (Department of Defence Veteran Affairs, 1998). The female population in this study was roughly evenly distributed between the combat and non-combat professional arms. Proportionately, females constituted a
N 145 48 193 145 48 193
Mean Rank 101.26 84.15
Sum of Ranks 14682.00 4039.00
99.32 89.99
14401.50 4319.50
Sig
.066 .315
lower fraction of the combat arm (6.6%) than the noncombat (11.3%). More than half (56.3%) of the females and 1 in 5 (20.9%) of males were below the age of 30 years. This is in line with the fact that a vast majority of the fighting force are recruited from among the male population. Also presently, the Army recruitment targets mainly men and recruits based on a female proportion of only 7-7.5% (Department of Defence Veteran Affairs, 1998). The age range of respondents was between 22 years and 57 years with a mean of 37.8 ±8.7years. This is not surprising as the target population was that of a Divisional level military facility where longer serving personnel are expectedly found. According to the Nigerian Army Order of Battle (ORBAT), a Division is the most senior level field formation and is expected to have proportionately greater number of senior and more experienced personnel who would have risen in service from the company to battalion level through the brigades (The Presidential Guidelines for the Nigerian Army, 2001). The age distribution is comparable to the population based study of 8441 personnel of the Canadian Army studied by Sareen et al (2007) who had a lower limit of 16 years and an upper limit of 54 years
118 Merit Res. J. Med. Med. Sci.
(Sareen et al., 2007). Majority of all the subjects (80.8%) were married. However, within the married category, a vast majority (94.2%) were males showing a higher percentage proportion of married males than married females in the service. There is a similar pattern in the US army with more men than women being married but markedly different in terms of the relative proportions where 55% and 44% of males and females respectively were married (Department of Defence Veteran Affairs, 1998). The marriage institution places an added burden of spousal and family responsibilities upon personnel (Dimicelli et al., 2010). For example, frequent relocations and transfers, often at short notice is a hallmark of military service with need for school changes and other problems of family dislocation; long absences while on mission deployment and consequent domestic/spousal challenges of separation; family and children health needs as well as an increased financial burden and so on all combine to multiply the stresses of married servicemen/women. This study identified 9 out of the 15 coping strategy domains that had statistically significant correlations with morbidity. “Behavioural disengagement, focus on and venting of emotions and alcohol/drug use” were positively associated with the highest number of morbidities. “Problem Focused Coping” had a positive correlation with a diagnosis of normal (P=0.025) (Table 6a); this means that those who were diagnosed as normal after the CIDI interview were also found to use more of that coping strategy. This trend is supported by previous studies of combat stress disordered soldiers (Solomon and Mikulineer, 1988). “Focus on and Venting of Emotions” (p=0.000), “Mental Disengagement” (p=0.035), “Behavioural Disengagement” (p=0.004), “Alcohol and Drug Use” (p=0.014) (Table 6a) were negatively correlated with an assessment of “Normal”. This suggests that these coping strategies are maladaptive. Respondents with Social Phobia used more of “Behavioural Disengagement” (P=0.028); Specific Phobia cases used less of “Active Coping” (p=0.049), and more of “Focus on and Venting of Emotions” (p=0.000) and “Mental Disengagement” (p=0.046) (Table 6a). Additionally, those with depression were found to use less of “Turning to Religion” (0.050) as a coping style but they used more of “Behavioural Disengagement”. This suggests that turning to religion might have some protective effect against depression or that behavioural disengagement predisposes to depression. Respondents who admitted to the use of alcohol were found to make significantly greater use of “Focus on and Venting of Emotions” (p=0.006), “Alcohol and Drug use” (p=0.021) for coping with stress and significantly less of “Problem Focused Coping” (p=0.012) (Table 6a). Individuals with Generalized Anxiety Disorder showed a negative correlation with “Seeking Instrumental Social Support”
(p=0.021) implying that they used significantly less of that coping style; those with Intermittent Explosive Disorder showed a significantly greater use of “Behavioural Disengagement” (p=0.036) and used less of “Problem Focused Coping “(p=0.024) and “Emotion Focused Coping” (p=0.008). Respondents who were positively identified with PTSD were also found to make significantly greater use of “Behavioural Disengagement” (p=0.020) while Panic disorder was also positively correlated with “Behavioural disengagement” (0.020), “Mental Disengagement” (0.010), and “Alcohol/Drug Use” (0.025) (Table 6a). There was however no statistically significant correlations of any particular coping strategy with psychosis or BAD demonstrated. It then means that BAD or psychosis might have underlying biological features. Several studies have shown similar and various other associations between coping and psychiatric morbidity; Georgian servicemen were found to use more problem focused coping than their civilian counterparts and this was associated with their lower manifestation of depression, somatization and hypochondriasis (Khechuashvili, 2009). Johnsen et al (1998) found sustained higher GHQ scores in avoidance copers (Johnsen et al., 1998). Nagase Y et al in Japan found that in relation to depression, the significantly highest odds ratios were for avoidant coping and the lowest for problem focused coping in both genders (Haghighatqou and Peterson, 1995). Other authors such as Rodriguez et al (2010), found emotion focused coping was related to higher PTSD symptom severity in moderate combat exposure; Gilbar et al (2010) reported greater symptoms of psychological distress in relation with emotion focused coping while Lai in 2004 observed an positive association between emotion focused and escape coping mechanisms and depressive symptoms in raw soldiers (Spence et al., 2002; Lai, 2004; Dhir et al., 2008; Rodriguez and Renshaw, 2010). These findings are thus in line with the above mentioned findings in this study regarding the relationship between coping and morbidity indicating a predictable pattern of psychological response to stress across the mentioned populations. A logistic regression with morbidity as the dependent variable and coping strategies and subsequently sociodemographics as independent variable was carried out. Three coping strategies were found to be independently associated with psychiatric morbidity. These are, suppression of competing activities (P = 0.036, OR = 1.231), Acceptance (P = 0.016, OR = .805) and Focus on and venting of emotion (P = 0.012, OR = 1.230). This means that individuals were less likely to develop psychiatric morbidity the greater the use of acceptance while they were 1.2 times more likely to have a psychiatric morbidity the greater the use of each of suppression of competing activities and focus on and venting of emotions as coping strategies. Not much was
Adole et al. 119
found in the literature regarding the use of suppression of competing activities and acceptance, although the authors of the COPE scale regard acceptance as an adaptive coping style especially in later stages of terminal illness or in cases of persistent, inevitable stress. The persistent stress of regimented life, frequent displacement, and combat exposure as expected in military tasks require acceptance and subordination to authority for adaptive functioning and a successful career trajectory. This may explain the inverse association of acceptance with morbidity in the logistic regression. In the case of suppression of competing activities, the positive association with morbidity could be attributable to the highly stressful and demanding multiplicity of tasks faced by soldiers in the face of limited time as well as the culture of task performance ‘with immediate effect’ as is common in the Army. In such circumstances, ability to multi-task is essential for adaptive functioning. Thus service personnel whose coping style is characterized by suppression of competing activities could be prone to symptoms of psychological stress. This possibly accounts for the positive association with morbidity in the regression. While there was no statistically significant difference in the use of problem focused coping and emotion focused coping among respondents, the problem focused coping has been significantly associated with an assessment of normal. Emotion focused coping has also been variously associated with psychological distress, and other psychiatric morbidity especially depression, PTSD, and various neurosis (Lai, 2004; Solomon and Mikulineer, 1988; Rodriguez and Renshaw, 2010; Gilbar et al., 2010). The above results support the poor reputation of emotional focus coping (EFC) as a coping mechanism and the need to train personnel on emotional control and relaxation techniques. CONCLUSION The study found that nine coping strategies were maladaptive with emotion focused coping showing a greater positive correlation with morbidity. RECOMMENDATION A curriculum on coping skills training should be developed by the army. Training and cadre programs, particularly at earlier/junior rank stages should focus on a deliberate development of adaptive coping skills focused on active coping, acceptance, instrumental social support, planning and turning to religion. Cadre/training programs should be strengthened and re-structured/designed to actively discourage the use of
focus on and venting of emotions, mental/behavioural disengagement as well as alcohol/drug use for coping with stress. Limitation Specific details of locations, job descriptions and certain socio-demographic parameters such as religion could not be elaborated due to peculiarities of the army. The version of the COPE Scale used in this study has not been validated in a military population in Nigeria. Additionally, although the dispositional implication of the instrument helps to reduce the complexity of coping assessment, it does so at a high price; it assumes that uniqueness of situation-specific coping responses only represents a negligible aspect of coping strategy (Schwarzer and Schwarzer, 1996). Specific diagnosis of personality disorders and schizophrenia could not be established using the CIDI. REFERENCES Ames GM, Cunradi C (2004/2005). Alcohol use and preventing alcoholrelated problems among young adults in the military. Alcohol Research &Health,; 28(4): 252–57. Ames GM, Cunradi CB, Moore RS, Stern P (2006). Military culture and drinking behavior among U.S. Navy careerists. Journal of Studies Alcohol and Drugs, 68(3):336–344. Bremner JD, Southwick SM, Darnell A, Charney DS (1996). Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse. American Journal of Psychiatry, 153(3): 369–75. Cheng KG, Ortiz DJ, Weiss RE, Shi L, Ovalle-Bahamon RE, Ernesto F, Grillo MP and Bing EG (2011). Patterns of alcohol consumption and factors influencing problematic drinking among Angolan soldiers. Journal of Substance Use [Online] Jan 10; [cited 2011Jan 11]. Available from: http//www.informahealthcare.com. Department of Defence Veteran Affairs (1998). Marital status of active component enlisted members. Dhir C, Banerjee A, Chaudhary S, Singh Z (2008). Neuroses among Armed Forces Personnel. MJAFI, 64: 136-39. Dimicelli E, Steinhardt MA, Smith SE (2010). Stressful experiences, coping strategies, and predictors of health-related outcomes among wives of deployed military servicemen. Armed Forces and Society, 36(2), 351-73 Galen LW, Rogers WM (2004). Religiosity, alcohol expectancies, drinking motives and their interaction in the prediction of drinking among college students. Journal of Studies on Alcohol, 65(4): 469– 76. Gilbar O, Ben-Zur H, Lubin G (2010). Coping, mastery, stress appraisals, mental preparation, and unit cohesion predicting distress and performance: a longitudinal study of soldiers undertaking evacuation tasks, Anxiety Stress and Coping, 23(5): 547-62. Gureje O, Uwakwe R, Oladeji B, Makanjuola VO, Esan O (2010). Depression in adult Nigerians: results from the Nigerian Survey of Mental Health and Well-being Journal of Affective Disorders, 120(13):158-64. Haghighatqou H, Peterson C (1995). Coping and depressive symptoms among Iranian students, Journal of Social Psychology, 135(2):17580. Hooper R, Rona RJ, Jones M, Fear NT, Hull L, Wessely S (2008). Cigarette and alcohol use in the UK Armed Forces, and their association with combat exposures: A prospective study. AddictiveBehaviors, 33(8): 1067–71.
120 Merit Res. J. Med. Med. Sci.
Hunter CL, Talcott GW, Klesges RC, Lando H, Haddock CK (2000). Demographic, lifestyle, and psychosocial predictors of frequency of intoxication and other indicators as estimates of alcohol-related problems in Air Force basic military recruits.Military Medicine, 165: 539–45. Johnsen BH, Laberg JC, Eid J (1998). Coping strategies and mental health problems in a military unit. Military Medicine, 163(9):599-602. Karlovic D, Marusic S, Martinac M (2004). Increase of serum triiodothyronineconcentration in soldiers with combat-related chronic post-traumatic stress disorder with or without alcohol dependence. Wiener KlinischeWochenschrift, 116(11–12): 385–90. Khechuashvili L (2009). Coping strategies and personality profile of the Georgian militaries. TiblisiState University [Online] Pub Nov 3 [cited 2011May 4]. Available from: http//www.press.tsu.ge. Koenen KC, Lyons MJ, Goldberg J, Simpson J, Williams WM, Toomey R, Eisen SA, True W, Tsuang MT (2003). Co-twin control study of relationships among combat exposure, combat-related PTSD, and other mental disorders. Journal of Traumatic Stress, 16(5): 433–38. Lai TJ (2004). A study of stress, depression symptoms and coping behaviors in recruited soldiers, (unpublished thesis), National Defense Medical Center, Taipei, Taiwan MacQueen KM, Nopkesorn T, Sweat MD, Sawaengdee Y, Mastro TD, Weniger BG (1996). Alcohol consumption, brothel attendance, and condom use: normative expectations among Thai military conscripts. Medical Anthropology Quarterly,; 10: 402–23. Mehlum L (1999). Alcohol and stress in Norwegian United Nations peacekeepers. Military Medicine, 164(10): 720–24. Moore RS, Ames GM, Cunradi CB (2007). Physical and social availability of alcohol for young enlisted naval personnel in and around home port. Substance Abuse Treatment Prevention and Policy, 2: 17.
Mueller M, Kipke I, Frey F, Rossler W, Lupi G, Vetter S (2009). Antecedents and covariates of alcohol consumption among Swiss male conscripts. International Journal of Environmental Research and Public Health,; 6: 958–970. Okulate GT (2005). Psychiatric referrals during peace and wartimes: a Nigerian experience.Military Medicine, 170(7):563-5. Rodriguez CS, Renshaw KD (2010). Associations of coping processes with posttraumatic stress disorder symptoms in national guard/reserve service members deployed during the OEF-OIF era. Journal of Anxiety Disorders, 24(7):694-9. Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G, and Asmundson GJ (2007). Combat and peace keeping operations in relation to prevalence of mental disorders and perceived need for mental health care. Archive of General Psychiatry, 64(7): 843-52. Schwarzer R, Schwarzer C (1996). A critical survey of coping instruments. Handbook on coping. [Online] [cited 2011 Jan 6]. Available from: http://userpage.fuberlin.de/~gesund/publicaut/copchap6.htm. Solomon Z, Mikulineer M (1988). Attributional style and combat related posttraumatic-stress disorder. Journal of Abnormal Psychology, 97:308-13. Spence SH, Sheffield J, Donovan C (2002). Problem-solving orientation and attributional style: moderators of the impact of negative life events on the development of depressive symptoms in adolescence? J. Clinical Child Psychology, 31: 219–229. The Presidential Guidelines for the Nigerian Army (2001)
